What a process...

It's turning out to be quite the process looking for a midwife and finding out what each one provides and what each one doesn't provide. I'm looking at certified midwifes that way if I happen to hemorrhage and the herbal stuff doesn't work she can give me a shot of pitocin if it's needed with out having to transfer me to a hospital. I would like to avoid any hospital stay as much as possible. Out of the half dozen that are with in an hour of me I have only found one. I've talked to her already and I actually really enjoyed talking to her over the phone. Well I e-mail her to get a little more detail on what she provides and what I need to provide. She lives just a little over an hour away and her office is there as well and I hate driving that far for an appointment, I would do it if I had to though, well she will actually do home visits for the appointments but she charges a little extra. I thought that was so cool! She also said that I would have to provide basically everything else. I would need to order a kit and provide the towels, wash clothes, garbage bags, that sort of thing. I'm also looking at a birth tub as well. I'm thinking this is going to be, after all the dust settles, around $3,000, $1,800 for the birth and then everything else I will have to purchase. They have an awesome BC, it's a converted old, beautiful, house but I really don't want to travel an hour to the BC while in labor and I really want a home birth anyways. The appeal of the center is it would only be $2,000. I'm waiting for her reply back on how much extra home visits will be and that just may be a deciding factor for DH and I. I know DH was already wondering if she would do home visits for the entire pregnancy so I know he will like it.

There is another midwife center that's only a half hour away but none of their midwifes are certified. They charge around $3,000 and provide EVERYTHING.

I'm so glad i'm doing my research now rather than later when I am already expecting. The great thing is, if I decide to go with the certified midwife then I can start getting supply's now so I don't have one HUGE purchase at the end to go along with paying the midwife.

Oye. Looks like lots of praying is ahead for me. As well as possibly some meeting of midwifes.

I don't think I took this much care in choosing my doctor. I just wanted a female OB.

Well, looks like I may be paying out of pocket weather I go with a birth center or home birth. The lady I talked to a few months ago didn't look at our plan specifically. A home birth is not covered at all and a midwife and birth center is 100% covered IF they are in-network but from what I can find none of the midwifes around here are in-network providers. If I go with an out of network provider we'll just have to pay out of pocket.:confused: Kind of sucks because a hospital birth is 100% covered as long as it's in network and the one we go to is. All we pay is one co-pay at the beginning.

GRRRRR. I'm so frustrated right now. :mad: It bugs me so bad when people tell you wrong. When I called earlier today I called twice and talked to 2 different people and they both told me the same thing. Of course with the way DH's work is it wouldn't surprise me if they change insurance by next year (they have changed it every year sense we've been married) and maybe they will go with someone that will cover a home birth. A woman can dream right?:rolleyes:

What state are you in? (You don't have to say online, I'm just asking in general terms, kwim?) Many states have a law requiring coverage of out-of-network birth services at the regular out-of-network rate. So if you got an out-of-network cardiologist and they'd cover 60% of his bill, you can get your out-of-network midwife covered for 60%. What I'm saying is, if your insurance provides out-of-network coverage for one thing, in many states they must cover it for birth, and if they cover any birth services, in many states they must cover home birth. They are paying for the service, not for who provides the service or where. If your state licenses certified midwives, insurance companies are often required to cover them just as they would cover any other licensed care provider. Check your state laws, don't rely on your insurance company to tell you the truth. Ask your midwife, too, she might have experience dealing with your insurance!

Are CPMs permitted to attend HBs in Utah? Back to the CPM/CNM thing, if you can find a CPM who has a back-up provider that she works with, then they will give you a prescription for pitocin that you can have on hand for hemorrhage if that is the only reason you would rather have a CNM. That's what my CPM MW in West Virginia would have done, but there is no legislation restricting them there.

Also, something that I had considered in Alaska is filing for their medicaid (Denali Kidcare). It is the public assistance program provided for children to age 18 and pregnant women. As PP said, some states require insurance to cover certain things, and if I had gone with their medicaid, then I would have had more flexibility than I would have with our insurance, and they would have covered a BC. I would have had to drop our insurance for that time period though.

Even if you don't go with this particular MW that you are looking at, ask her these questions. She can probably give you more information especially regarding the laws in your particular state... or if she doesn't know, I'm sure she can refer you to someone who does. I have found every MW that I have ever contacted to be a wealth of information, and they are always so willing to share and help in whatever way they can. MWs are truly wonderful people from what I have found.

GL! And you are making such a great start by doing all of this research now. I'll be interested to see what you find out!

I have heard from some women that their home births were eventually covered by their insurance companies despite being told that they wouldn't be. It's not something to bank on but I know it's possible! Good luck with your search!

Finding a MW is some areas is totally a process. Good for you for starting early. We only found 2 MW that would attend our rural area, everyone else said no way. We do the 1 hour each way travel to see the one we picked for each appt. Of course neither of them were in-network with our insurance and they tried to tell us that they wouldn't cover it. I was a pain in their side for a while and it finally did come out that they would cover the out-of-network 60%. Small victory. We still have to front 100% of the cost and then get reimbursed after the birth. So keep checking with them because maybe something will change and they will cover some of it! Best of luck!

I live in Utah. The problem is, now that I look at our plan, our insurance wont cover ANY out-of-network provider. Not even out-of-network hospitals.

Maybe one of our Utah moms can weigh in on this, I know we have a few here. If not, then I'd suggest that you call your state insurance commissioner's office. If your state licenses midwives, then insurance companies should be required to cover them as they would any other birth service provider. If midwives are something new, this might still be worked through the kinks, kwim? Don't let it drop, ask for a waiver, show them how much they'll save for a HB midwife over a hospital, see if they'll come around. They *can* make individual exceptions. But FWIW, I have an HMO so no out-of-network coverage at all, and both my midwives were well worth the money, even though I ended up with c-sections both times.

Well, I've researched and tried about everything I can. Talked to a midwife and she told me that everything I had tried had already been tried before to no avail. I did find a CNM that is covered by our insurance though, but it will be another hospital birth. I have heard good things about this hospital though, so I hope that holds true. If I went with a BC I would pay out of pocket and there are very few BC here in Utah and only one that is a licensed BC down south for the polygamists. So if I want a BC at all it would be out of pocket. Stupid thing is if we had the right "plan" with our insurance a home birth would be covered.

I so wish we could afford the out of pocket pay for a BC but unless finances improve in the next year it's not going to happen. There is no way we would be able to afford paying for a home birth.

I'm in Utah and have been actively involved with legal issues surrounding home birth midwifery since 2003. Here are some general facts about out-of-hospital birth in Utah:

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In order for a home birth midwife to legally obtain and administer emergency medications such as pitocin, she must be licensed by the state of Utah. The credential is LDEM (Licensed Direct-Entry Midwife). The licensure requirements are based on the CPM credential (Certified Professional Midwife). Most LEDMs are also CPMs. Some CPMs choose not to license with the state. NARM is the certifying body for CPMs. You can read about their requirements here: http://www.narm.org/htb.htm#edcategory

Licensure of home birth midwives is voluntary in Utah. This means that women have a choice of licensed or unlicensed midwives. Unlicensed midwives are not legally able to obtain and/or administer emergency medications. Licensed midwives are not legally able to attend births of a woman carrying a baby in a breech presentation, twins, or if she has had more than two prior c-sections and/or her scar is other than low and transverse. There are other situations that require consultation with a physician, but may not necessarily risk a mother out of the care of a midwife. You can read more about the legal issues here: http://www.dopl.utah.gov/laws/58-77.pdf

There are a few "birth suites" (Bella Natal, Birthing Your Way, and Great Expectations) in the area that offer a birth center-like out-of-hospital birth option. The licensure requirements for birth centers in Utah are ridiculous, so that is why you don't see more of them. I know that people are working to get the birth center licensing rules changed to be more reasonable.

There are many, many licensed home birth midwives in the area. I feel very comfortable about recommending some of them and am frightened by others (one severely mismanaged by SIL's birth). It is (obviously) still very important to ask lots of questions about an individual midwife's safety record and practice style. My top picks are Suzanne Smith, Trinette Thompson, Cathy O'Bryant, Brigitte Eastman, Heather Johnston, and Holly Richardson. There are competent unlicensed midwives as well (and some that concern me).

I'm aware of only one CNM (Certified Nurse Midwife) that attends out-of-hospital births in Utah. Her name is Rebecca Williams. Here is her website: http://www.greatexpectationsbc.com/

It is extremely rare for home birth to be covered by insurance in Utah. I did get United Health Care to pay a few hundred dollars toward my third baby's birth, but we paid out-of-pocket for the bulk of the fee for it and our three other home births. We were able to reduce the costs by paying out of my husband's flex spending account at work.

I hope this information helps clear things up and that you find a great care provider for your next baby's birth.

That group of midwives is the one I used for my DD's birth. The midwife who caught her is no longer there (she must have moved or something), but Kathryn and Claudia were part of the practice at the time. You see all of them during your prenatal care (or you're supposed to anyway...I didn't because I switched to them so late in my pregnancy), and they rotate call shifts, so whoever is on-call when you go into labor is the one who attends your birth. I chose them because I heard they were the best CNM practice in the area. Although my birth didn't go as planned, I was happy with the way I was treated by the midwives and by the nurses at the hospital. The nurses at AFH are used to natural births because they have so many of the midwives patients, so you won't get resistance like you experienced with your first birth at the hosptial you were at. The midwives do have to follow hospital protocols (including things like inducing for PROM ;)), and if the on-call OB tells them to do something, they kind of have to do it (which is part of what went wrong with my DD's birth), but otherwise, they are really great care providers.

Like Mango said, it is a rotating group. Most of my hospital-birthing studets use them and do very well. American Fork has a better reputation than Timp, but if you clearly state your preferences at Timp they'll do pretty well at following them. I like Danielle Demeter (Park City) and Julie Jones (Riverton) for hospital-based CNMs that always go for their patients.

If you really prefer home birth, you have time to save up for it considering you're not even pregnant yet. More important to me than finances was to choose a birth location and caregiver that inspired confidence and safety. While we didn't have the couple of thousand bucks just lying around, we made it a financial priority to pay for a midwife. I'd much rather have a bit of credit card debt than another traumatic/meddled with birth.

A mom should not choose a home birth just because it is cheaper if she really feels safer in a hospital. A mom should not choose a hospital birth because it is covered by insurance if she really feels safer at home.

Like Mango said, it is a rotating group. Most of my hospital-birthing studets use them and do very well. American Fork has a better reputation than Timp, but if you clearly state your preferences at Timp they'll do pretty well at following them.

Oh yeah, I had DD at American Fork, if that wasn't clear. The midwives attend births at both.

A mom should not choose a home birth just because it is cheaper if she really feels safer in a hospital. A mom should not choose a hospital birth because it is covered by insurance if she really feels safer at home.

This is a good point. Is there anything in your budget you can cut out and start saving up a birth fund? I know you said a while ago that you were buying a house, so I don't know if your finances have any wiggle room at this point or not. You also may be able to find a midwife who will work with you on the cost--either give you a discount based on income or do some kind of barter with you if you have some kind of service she can use.

Oh yeah, I had DD at American Fork, if that wasn't clear. The midwives attend births at both.

This is a good point. Is there anything in your budget you can cut out and start saving up a birth fund? I know you said a while ago that you were buying a house, so I don't know if your finances have any wiggle room at this point or not. You also may be able to find a midwife who will work with you on the cost--either give you a discount based on income or do some kind of barter with you if you have some kind of service she can use.

Yeah right now we just don't have any wiggle room. By the time we pay our house payment, utilities, gas, water softener payment, and truck payment, we barley have enough to get gas in both vehicles and groceries for the month (and we spend no more than $150 for groceries for an entire month). Our house payment takes up an entire check of DH's so all the other expenses come out of the second check. The midwives i've talked to will do payments up till 36 weeks when they want it paid in full but we still just can't afford it. My only other option is set away a chunk of our tax money next year for it but I don't even know if we will even get enough back in taxes for that.

Still keeping my options open at this point as I have no idea if DH's work will keep this insurance or if they will switch insurances next year like they have done every year for the past 4 years and see how we feel when the time gets closer anyway. I know my options now at least and now have plenty of time to pray about it and decide what path to take. I'm just trying my hardest to not let my feelings get to attached to an idea that we might not be able to do. But honestly I really really don't want another hospital birth. Even if this hospital is better, it just doesn't feel right.